Healthcare costs are high – not using an agent can make them higher

You can enroll on your own, or you can use a local agent who specializes in health insurance. Your choice. Lynne Sladky, AP.

by Rob Howard
Associate Editor

Figuring your way through the details and costs of health insurance is a daunting task. “With the ongoing changes in recent years in health insurance, you need someone that stays on top of the law and understands how it works,” says healthcare insurance specialist Jim Walters.

Uncertainty swirls around the Affordable Care Act (ACA), and the Nov. 1 – Dec. 15 enrollment period is shorter this year than previous years. What might surprise you is you’re better off finding a local agent who specializes in health insurance than going online at and getting help from a “Navigator”.

There are significant benefits to using a local agent. “It is always better when buying health insurance to use an agent. It doesn’t cost you any extra to do so. But you always have someone there for you,” Walters asserts.

What might cost extra is if you don’t use an agent. Understanding your anticipated total cost for healthcare in a year is a complicated task. Many people just look at the monthly premium.

Walters says that can be a costly mistake. You have to look at the interplay of the premium, any federal subsidy you may be eligible for, deductibles and their effect on when you will start getting benefits and co-pays.

One of the biggest factors is how the deductible works on the policy you choose. “You have to factor in your deductible, because some of the plans don’t have drug coverage available until you meet the deductible,” notes Walters. “An agent helps you understand all the costs.

“Sometimes you can pay just $20 more a month for a lower deductible. It might be worth it to spend more to save those front end costs so their doctor visits are covered immediately or their drug plan kicks in immediately.”

Physician choice is, “One of the most critical points. Sometimes there can be a huge difference in their costs if they are adamant about keeping a physician.”

As an example, Walters talks about people who are hesitant about abandoning their long-time doctor, “Dr. Smith”. “We look, and Dr. Smith is not in the network. It might cost $400 a month more to keep Dr. Smith.”

People who understand how many components there are to choosing a health plan will probably not take on the task of shopping on the Federal Marketplace without assistance. The website offers “Navigators” who will help people complete their enrollment, but Walters pointed out that many of them are not specialists in health insurance.

“I know they are very well intentioned people and they are working very hard. But, they don’t have to take continued training for policies and insurance. Local agents have to stay accredited every year and hold a valid state insurance license. It’s important to keep up with how things are both at the federal level but also in [your own state], in particular.”

Walters spends more time with people getting to understand their income and the total they can afford to spend on healthcare. He then helps them enroll on, makes sure all the questions are answered that establish eligibility for subsidies and then helps them sort through the policies that are available in their area.

He sees his job as helping people get the best coverage and overall cost they can afford, and then to be there through the year to help his clients if they have any problems.

“No matter whether you use me as an agent, or someone else, please use a local agent when you are picking your health insurance plan, to get all the personal attention you can,” he concludes.

Copyright The Gayly – October 18, 2017 @ 7:10 a.m.  CDT.